Traumas to the brain caused by outside physical forces acting on the skull or spinal chord (hereinafter, head or spine injury), ischemic stroke, and hydrocephalus are all characterized by edema and resultant swelling. The standard treatment has been the administration of steroids, because of their known antiinflammatory activity or procedures such as the insertion of a shunt in the case of progressive hydrocephalus. Diuretics have not been used to treat brain and spinal chord edema partly because the blood-brain barrier prevents adequate concentrations of the diuretics from reaching brain cells. Thus, any decrease in edema following diuretic administration would be a secondary or independent effect resulting from general electrolyte loss and resultant dehydration of the rest of the body. Such dehydration would be inappropriate to someone with a traumatized brain or spinal cord.
Long, et al., Dynamics of Brain Edema, pp. 293-300, Springer-Verlag (1976) described the use of the diuretics furosemide and acetazolamide for the treatment of certain models of brain edema in cats.
Bourke, et al., Brain Research, 105 (1976) 309-323 described the effect of the diuretics ethacrynic acid and acetazolamide on swelling of monkey cerebrocortical slices. Nelson, et al. Neural Trauma, edited by A. J. Popp et al., Raven Press, New York, 1979, p. 297, have described the use of ethacrynic acid in brain injury.